Periodic Survey of Fellows

Most pediatricians promoting physical fitness, nutrition

Eight out of 10 pediatricians talk to children and their parents about the benefits of regular moderate-to-vigorous physical activity and encourage their participation in "lifetime" activities that promote fitness (85.9 percent, 79.2 percent, respectively), according to a 1995 AAP Periodic Survey of Fellows.

More than half (57.6 percent) encourage parents to plan physical activities regularly for their family, while 34.7 percent inquire about the parents' level of physical activity. Parents, however, generally do not seek information about physical activity. On average, pediatricians say, only about 13 percent of parents ask for suggestions on which physical activities to initiate - either for the child or for the family - and only 11 percent ask how to begin or get involved in fitness activities.

Although pediatricians inquire about various aspects of physical fitness among their patients of all ages, most pediatricians do so with patients older than 5 years of age. More than half (57.2 percent) of pediatricians ask grade school children (ages 5-12 years) and 62.8 percent ask adolescents (ages 13 years and older) about the frequency and time they spend in physical activities, while less than one-third (30.2 percent) address this topic with patients 5 years of age and younger. More than 80 percent of pediatricians ask grade school patients and adolescent patients what specific physical activities they are involved in (83.4 percent and 87.3 percent, respectively), while only 44 percent inquire about the type of activities in which preschool patients are involved. More pediatricians talk to grade school patients about their TV watching and video game playing habits than to adolescents or preschoolers (61.4 percent vs. 49.3 percent vs. 45.3 percent).

Overall, nearly all pediatricians who provide preventive care counsel patients about proper diet/ nutrition as part of their health supervision: 90.7 percent inquire about the nutritional habits of patients under age 6, 88.7 percent routinely make such inquiries of grade school children and 85.5 percent ask adolescents about their diet.

Nearly all pediatricians recognize the importance of physical fitness in the prevention of adult lifestyle-related diseases, and most think it is their responsibility to advise patients and parents regarding fitness. However, they are pessimistic about the effect their advice has on patients and parents, as well as the benefits and feasibility of administering formal fitness tests in their office.

An overwhelming majority of pediatricians (88.9 percent) think adult lifestyle-related diseases such as heart disease, hypertension and obesity may be prevented by emphasizing physical fitness in childhood or adolescence. Eighty-six percent agree parents must incorporate fitness activities into their family's lifestyle in order for advice on youth fitness to be effective. More than half (59.7 percent) agree it is a pediatrician's responsibility to be his/her patients' main source of information on exercise and diet for physical fitness, while about one-fourth are undecided. Pediatricians are fairly evenly divided in their belief that children and their parents will follow their directives on obtaining and maintaining physical fitness (27.2 percent agree, 33.4 percent disagree and 38.9 percent are undecided).

Only about one-fourth of pediatricians (23.4 percent) believe physical or instrument tests of fitness would benefit most children and only 37.7 percent think children should be formally measured and assessed for fitness as part of health supervision visits, although a large portion of pediatricians are undecided. Most pediatricians (91.2 percent) rarely or never administer any physical or instrument tests in their office to measure body composition, cardiorespiratory fitness, flexibility or strength/endurance, nor do they refer patients to another source for tests that measure fitness level (81.6 percent rarely or never refer.) Most pediatricians (56.3 percent) do not know whether the schools in their practice community have a program that regularly measures (using physical tests, instruments or machines) students' fitness level.

AAP Periodic Survey 29 was conducted from April to July 1995. Surveys were mailed to a random sample of 1,612 active AAP members in the United States. In total, 1,189 questionnaires were completed for a 76 percent response rate. Physical fitness and nutrition counseling questions were addressed to the 926 pediatricians who provide preventive care.

Table 1: Health Supervision Regarding Physical Fitness by Patient Age Group

Percent of Pediatricians Who Inquire About:	Preschool <5 Yrs	Grade School 5-12 Yrs	Adolescents 13+ Yrs
Specific types of physical activities in which the patient is involved	44.0	83.4	87.3
The frequency and amount of time spent in physical activities	30.2	57.2	62.8
The amount of time spent watching TV or playing video games	45.3	61.4	49.3
Patients' nutritional habits	90.7	88.7	85.5

Table 2: Pediatricians' Attitudes Toward the Benefits and Importance of Physical Fitness Counseling and Measurement

	Percent of Pediatricians
	Agree	Neutral	Disagree
Emphasis on physical fitness in childhood or adolescence will help prevent adult lifestyle-related diseases	88.9	9.2	2.0
Pediatrician's responsibility to be his/her patients' main source of information on exercise and diet for physical fitness	59.7	26.1	14.2
Advice on fitness will not be effective unless parents incorporate fitness activities into their families' lifestyles	86.1	7.6	6.3
Children/parents will follow pediatricians' directions on obtaining and maintaining physical fitness	27.7	38.9	33.4
Many children would benefit from formal tests that measure their fitness level	23.4	37.7	38.8
Children's fitness level should be formally measured and assessed as part of health supervision visits	37.7	32.5	29.7
It is feasible for most pediatric practices to administer formal tests that measure a child's fitness level as part of routine health supervision	13.4	23.8	62.8